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Kampaite A, Gustafsson R, York EN, Foley P, MacDougall NJJ, Bastin ME, Chandran S, Waldman AD, Meijboom R. Brain connectivity changes underlying depression and fatigue in relapsing-remitting multiple sclerosis: A systematic review. PLoS One 2024; 19:e0299634. [PMID: 38551913 PMCID: PMC10980255 DOI: 10.1371/journal.pone.0299634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/13/2024] [Indexed: 04/01/2024] Open
Abstract
Multiple Sclerosis (MS) is an autoimmune disease affecting the central nervous system, characterised by neuroinflammation and neurodegeneration. Fatigue and depression are common, debilitating, and intertwined symptoms in people with relapsing-remitting MS (pwRRMS). An increased understanding of brain changes and mechanisms underlying fatigue and depression in RRMS could lead to more effective interventions and enhancement of quality of life. To elucidate the relationship between depression and fatigue and brain connectivity in pwRRMS we conducted a systematic review. Searched databases were PubMed, Web-of-Science and Scopus. Inclusion criteria were: studied participants with RRMS (n ≥ 20; ≥ 18 years old) and differentiated between MS subtypes; published between 2001-01-01 and 2023-01-18; used fatigue and depression assessments validated for MS; included brain structural, functional magnetic resonance imaging (fMRI) or diffusion MRI (dMRI). Sixty studies met the criteria: 18 dMRI (15 fatigue, 5 depression) and 22 fMRI (20 fatigue, 5 depression) studies. The literature was heterogeneous; half of studies reported no correlation between brain connectivity measures and fatigue or depression. Positive findings showed that abnormal cortico-limbic structural and functional connectivity was associated with depression. Fatigue was linked to connectivity measures in cortico-thalamic-basal-ganglial networks. Additionally, both depression and fatigue were related to altered cingulum structural connectivity, and functional connectivity involving thalamus, cerebellum, frontal lobe, ventral tegmental area, striatum, default mode and attention networks, and supramarginal, precentral, and postcentral gyri. Qualitative analysis suggests structural and functional connectivity changes, possibly due to axonal and/or myelin loss, in the cortico-thalamic-basal-ganglial and cortico-limbic network may underlie fatigue and depression in pwRRMS, respectively, but the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies. This highlights the need for further studies including advanced MRI to detect more subtle brain changes in association with depression and fatigue. Future studies using optimised imaging protocols and validated depression and fatigue measures are required to clarify the substrates underlying these symptoms in pwRRMS.
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Affiliation(s)
- Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecka Gustafsson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth N. York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Foley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Niall J. J. MacDougall
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Mark E. Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
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Pakenham KI, Landi G, Grandi S, Tossani E. The mediating role of psychological flexibility in the relationship between resilience and distress and quality of life in people with multiple sclerosis. J Health Psychol 2024; 29:65-80. [PMID: 37387365 DOI: 10.1177/13591053231182364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
The purpose of this study is to investigate the role of psychological flexibility in mediating the beneficial effects of resilience on distress and quality of life (QoL) in people with MS (PwMS). The psychological flexibility framework underpinning acceptance and commitment therapy (ACT) was used to conceptualise psychological flexibility. A total of 56 PwMS completed an online survey that assessed global psychological flexibility and each of its six core sub-processes, resilience, distress, mental and physical health QoL, socio-demographics, and illness variables. Mediation analyses showed that, as hypothesised, higher levels of global psychological flexibility and its sub-processes were associated with increases in the positive impacts of resilience on distress and mental and physical health QoL via a mediational mechanism. These findings suggest that psychological flexibility skills build resilience capacities in PwMS. The psychological flexibility framework offers an ACT-based intervention pathway to build resilience and enhance mental health and QoL in PwMS.
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Lo Buono V, Corallo F, Bonanno L, Pria D, Di Cara M, Palmeri R, D'Aleo G, Rifici C, Sessa E, Marino S, De Cola MC. Psychological symptoms in Multiple Sclerosis and the role of marital status: results from a retrospective single-center study. Mult Scler Relat Disord 2023; 79:105051. [PMID: 37820445 DOI: 10.1016/j.msard.2023.105051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/18/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Married people have, on average, better mental health than no married people. Psychological symptoms as anxiety and depression occur frequently in patients with multiple sclerosis (MS), increasing the severity of neurologic disability. The aim of this retrospective study was to investigate the relationship between functional disability and psychological symptoms differentiating by marital status. METHODS In this study 150 MS outpatients without a history of psychological disorders were selected from the hospital database. The outpatient procedure for all patients includes the administration of the Expanded Disability Status Scale and the questionnaire Symptoms Checklist-90-Revised (SCL-90-R) a multidimensional self-report inventory, consisting of 90 items covering nine clinical dimensions: somatization (SOM), obsessive-compulsive (OC), interpersonal sensitivity (IS), depression (DEP), anxiety (ANX), hostility (HOS), phobic anxiety (PHOB), paranoid ideation (PAR), psychoticism (PSY), and three global indices of distress: global severity index (GSI), positive symptoms total (PST) and positive symptom distress index (PSDI). According to marital status, subjects were subdivided in single, married (including cohabitants), and divorced (including separated). A nonparametric group comparisons analysis was performed, as well as multivariate analysis which included generalized linear regression models. RESULTS Regression results showed that functional disability was a significant predictor for all SCL- 90-R subscales. Moreover, it would seem that the single condition might be a protective factor for the development of psychological symptoms in SM patients. Notably, findings showed that younger subjects were predominantly single and had less psychological symptoms, whereas patients with greater psychological alterations were older in a stable affective couple relationship, presenting an elevation in depression, anxiety, somatization and compulsive, and obsessive scales. CONCLUSION Numerous factors contribute to the onset of psychological disorders in multiple sclerosis. Marriage does not represent a protective factor for the development of psychological symptoms in SM patients. Future investigation is needed to ascertain the prevalence and underlying causes of psychological symptoms.
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Affiliation(s)
| | | | - Lilla Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Deborah Pria
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | | | | | | | | | - Edoardo Sessa
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
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Grigorescu C, Chalah MA, Ayache SS, Palm U. [Alexithymia in Multiple Sclerosis - Narrative Review]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:404-413. [PMID: 35948023 DOI: 10.1055/a-1882-6544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Alexithymia is a multidimensional construct of personality implicating difficulties in identifying and describing another's feelings, and externally oriented thinking. It is broadly reported in psychiatric patients but has gained little attention regarding its occurrence and pathophysiology in multiple sclerosis (MS). This narrative review aims to address prevalence, etiology, neurobiological, and clinical findings of alexithymia. The prevalence of alexithymia in MS ranges from 10 to 53%. There seems to be an association with anxiety, depression, fatigue, and some aspects of social cognition, while the relationship with clinical and classical cognitive variables was rarely evaluated. Only a few studies referred to its pathophysiology assuming an aberrant interhemispheric transfer or regional cerebral abnormalities. The prevalence of alexithymia in MS and the potential negative impact on quality of life and interpersonal communication could severely impact clinical MS management and a screnning for these factors should be mandatory. Thus, further evaluation is needed concerning its relationship with clinical, emotional, and cognitive confounders. Large-scale studies employing neuroimaging techniques are needed for a better understanding of the neural underpinnings of this MS feature.
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Affiliation(s)
- Christina Grigorescu
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Ulrich Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München
- Medical Park Chiemseeblick, Bernau a. Chiemsee
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Sá MJ, Basílio C, Capela C, Cerqueira JJ, Mendes I, Morganho A, Correia de Sá J, Salgado V, Martins Silva A, Vale J, Sousa L. Consensus for the Early Identification of Secondary Progressive Multiple Sclerosis in Portugal: a Delphi Panel. ACTA MEDICA PORT 2023; 36:167-173. [PMID: 36735763 DOI: 10.20344/amp.18543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/24/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Multiple sclerosis is a disease with a heterogeneous evolution. The early identification of secondary progressive multiple sclerosis is a clinical challenge, which would benefit from the definition of biomarkers and diagnostic tools applicable in the transition phase from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis. We aimed to reach a Portuguese national consensus on the monitoring of patients with multiple sclerosis and on the more relevant clinical variables for the early identification of its progression. MATERIAL AND METHODS A Delphi panel which included eleven Portuguese Neurologists participated in two rounds of questions between July and August of 2021. In the first round, 39 questions which belonged to the functional, cognitive, imaging, biomarkers and additional evaluations were included. Questions for which no consensus was obtained in the first round (less than 80% of agreement), were appraised by the panel during the second round. RESULTS The response rate was 100% in both rounds and consensus was reached for a total of 33 questions (84.6%). Consensus was reached for monitoring time, evaluation scales and clinical variables such as the degree of brain atrophy and mobility reduction, changes suggestive of secondary progressive multiple sclerosis. Additionally, digital devices were considered tools with potential to identify disease progression. Most questions for which no consensus was obtained referred to the cognitive assessment and the remaining referred to both functional and imaging domains. CONCLUSION Consensus was obtained for the determination of the monitorization interval and for most of the clinical variables. Most questions that did not reach consensus were related with the confirmation of progression taking into account only one test/domain, reinforcing the multifactorial nature of multiple sclerosis.
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Affiliation(s)
- Maria José Sá
- Serviço de Neurologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Carlos Basílio
- Serviço de Neurologia. Centro Hospitalar Universitário do Algarve. Faro. Portugal
| | - Carlos Capela
- Serviço de Neurologia. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | | | - Irene Mendes
- Serviço de Neurologia. Hospital Garcia de Orta. Almada. Portugal
| | - Armando Morganho
- Serviço de Neurologia. Hospital Dr. Nélio Mendonça. Funchal. Portugal
| | - João Correia de Sá
- Serviço de Neurologia. Hospital de Santa Maria. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Vasco Salgado
- Serviço de Neurologia. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal
| | - Ana Martins Silva
- Serviço de Neurologia. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - José Vale
- Serviço de Neurologia. Hospital Beatriz Ângelo. Loures. Portugal
| | - Lívia Sousa
- Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Carvalho T, Gomes C, Rodrigues A, da Motta C. Neuropathic pain, cognitive fusion, and alexithymia in patients with multiple sclerosis: Cross-sectional evidence for an explanatory model of anxiety symptoms. J Clin Psychol 2023; 79:1342-1356. [PMID: 36651192 DOI: 10.1002/jclp.23483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/06/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
Multiple sclerosis (MS) presents a high prevalence, a marked increase worldwide, and a relevant impact on patients, public health, and society. Anxiety often cooccurs with MS and can contribute to the worsening of MS symptoms. However, knowledge about predictors of anxiety in Patients with MS (PwMS) is scarce. OBJECTIVE This preliminary study explored a novel model for anxiety symptoms in PwMS, including neuropathic pain (NeP), cognitive fusion (CF), experiential avoidance (EA), and alexithymia as explanatory factors. METHOD This cross-sectional study integrated two independent convenience samples: 107 PwMS recruited from the Portuguese Society for Multiple Sclerosis and 97 age- and gender-matched participants without the MS diagnosis (no-MS sample) recruited from the Portuguese general population. Self-report questionnaires that measured the constructs included in the model were administered to both groups. RESULTS PwMS showed significantly higher values regarding anxiety symptoms and their explanatory variables (NeP, CF, EA, alexithymia) in comparison to non-MS participants. In the MS sample, no correlations were found between anxiety symptoms and sociodemographic and clinical characteristics. NeP, CF, and alexithymia showed significant correlations with anxiety symptoms and significantly explained this symptomatology in simple linear regression models. Thus, these variables were retained in the multiple linear regression model and emerged as significant regressors that together explained 38% of the variance in anxious symptomatology in PwMS. CONCLUSIONS This preliminary study provides novel evidence on NeP and some maladaptive emotion regulation strategies related to EA/psychological inflexibility, as vulnerability to anxiety in PwMS can be considerably increased by CF and alexithymia. Clinical implications were discussed.
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Affiliation(s)
- Teresa Carvalho
- Instituto Superior Miguel Torga, Coimbra, Portugal.,Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | | | | | - Carolina da Motta
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Lusófona University, HEI-Lab: Digital Human-Environment Interaction Lab, Lisbon, Portugal
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Howlett-Prieto Q, Oommen C, Carrithers MD, Wunsch DC, Hier DB. Subtypes of relapsing-remitting multiple sclerosis identified by network analysis. Front Digit Health 2023; 4:1063264. [PMID: 36714613 PMCID: PMC9874946 DOI: 10.3389/fdgth.2022.1063264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
We used network analysis to identify subtypes of relapsing-remitting multiple sclerosis subjects based on their cumulative signs and symptoms. The electronic medical records of 113 subjects with relapsing-remitting multiple sclerosis were reviewed, signs and symptoms were mapped to classes in a neuro-ontology, and classes were collapsed into sixteen superclasses by subsumption. After normalization and vectorization of the data, bipartite (subject-feature) and unipartite (subject-subject) network graphs were created using NetworkX and visualized in Gephi. Degree and weighted degree were calculated for each node. Graphs were partitioned into communities using the modularity score. Feature maps visualized differences in features by community. Network analysis of the unipartite graph yielded a higher modularity score (0.49) than the bipartite graph (0.25). The bipartite network was partitioned into five communities which were named fatigue, behavioral, hypertonia/weakness, abnormal gait/sphincter, and sensory, based on feature characteristics. The unipartite network was partitioned into five communities which were named fatigue, pain, cognitive, sensory, and gait/weakness/hypertonia based on features. Although we did not identify pure subtypes (e.g., pure motor, pure sensory, etc.) in this cohort of multiple sclerosis subjects, we demonstrated that network analysis could partition these subjects into different subtype communities. Larger datasets and additional partitioning algorithms are needed to confirm these findings and elucidate their significance. This study contributes to the literature investigating subtypes of multiple sclerosis by combining feature reduction by subsumption with network analysis.
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Affiliation(s)
- Quentin Howlett-Prieto
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
| | - Chelsea Oommen
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
| | - Michael D. Carrithers
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
| | - Donald C. Wunsch
- Department of Electrical and Computer Engineering, Missouri University of Science and Technology, Rolla, MO, United States
| | - Daniel B. Hier
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States,Department of Electrical and Computer Engineering, Missouri University of Science and Technology, Rolla, MO, United States,Correspondence: Daniel B. Hier
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The Mediating Role of Stigma, Internalized Shame, and Autonomous Motivation in the Relationship Between Depression, Anxiety, and Psychological Help-Seeking Attitudes in Multiple Sclerosis. Int J Behav Med 2023; 30:133-145. [PMID: 35325406 PMCID: PMC9879833 DOI: 10.1007/s12529-022-10078-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depression and anxiety are commonly experienced in individuals with multiple sclerosis (MS) yet little is known about factors associated with psychological help-seeking attitudes in those with MS. METHOD The current study investigated whether increased stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationship between depressive and anxiety symptoms and psychological help-seeking attitudes in individuals with MS. Two hundred fifty-four participants with MS completed an online questionnaire assessing depressive and anxiety symptoms, stigma related to chronic illness, internalized shame, autonomous motivation, and psychological help-seeking attitudes. RESULTS Stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationships between increased depressive symptoms and anxiety symptoms and psychological help-seeking attitudes. The study also found that higher levels of chronic illness-related stigma and internalized shame were associated with more negative psychological help-seeking attitudes and higher autonomous motivation was associated with more positive psychological help-seeking attitudes. There were no direct effects of depressive or anxiety symptoms on psychological help-seeking attitudes. CONCLUSION The significant mediating roles of stigma-related chronic illness, internalized shame, and autonomous motivation indicate that these factors may be useful to include in future depression and anxiety intervention studies targeting MS populations.
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Brandão PDMF, Lino TB, Oliveira RTD, Parra AV, Andrade PHM, Christofoletti G. Age, motor dysfunction and neuropsychiatric symptoms impact quality of life in multiple sclerosis. Rev Bras Enferm 2022; 75:e20210207. [PMID: 35674578 DOI: 10.1590/0034-7167-2021-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to investigate the impact of age, motor dysfunction and neuropsychiatric symptoms on the quality of life of people with multiple sclerosis in comparison to healthy peers. METHODS a total of 141 participants were tested in a single session. The assessments were composed by general questionnaires applied in both groups and by specific instruments restricted to multiple sclerosis. Multiple regression models were applied to assess relationships between predictors and outcome. RESULTS age, motor dysfunction and neuropsychiatric symptoms explained 56.6% of quality of life of the multiple sclerosis group. Age and neuropsychiatric symptoms explained 36.6% of quality of life in the control group. Age impacted more the multiple sclerosis group than the control group. Neuropsychiatric symptoms affected both groups similarly. Motor dysfunction impacted 21.9% of the quality of life in multiple sclerosis. CONCLUSIONS the predictors explained considerable variance of quality of life in multiple sclerosis, which should guide public health policies.
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Affiliation(s)
| | - Tayla Borges Lino
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
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10
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Zarotti N, Eccles F, Broyd A, Longinotti C, Mobley A, Simpson J. Third wave cognitive behavioural therapies for people with multiple sclerosis: a scoping review. Disabil Rehabil 2022; 45:1720-1735. [PMID: 35514235 DOI: 10.1080/09638288.2022.2069292] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Multiple sclerosis (MS) is a chronic condition linked to a wide range of psychological difficulties. While traditional cognitive behavioural therapy has been studied extensively with people with MS, much less is known about more recent "third wave" approaches. METHODS A scoping review was carried out by performing a systematic search across MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library up to January 2022. RESULTS From an initial return of 8306 citations, 35 studies were included, 20 of which were randomised controlled trials (RCTs). These showed that four third wave approaches have been investigated with people with MS to date: acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). MBSR and MBCT may be helpful to address a range of psychological difficulties up to three months post-intervention. However, MS-specific adaptations may be required, and more evidence is needed on longer-term effectiveness. Limited evidence is also available for DBT and ACT, but additional research is warranted before any recommendation can be made. CONCLUSIONS As third wave approaches keep being refined, further more rigorous investigations are needed to implement them to the benefit of people with MS. Implications for RehabilitationMultiple sclerosis is linked to a wide range of psychological difficulties in adults.Little is currently known on third wave psychotherapies for people with MS.Mindfulness-based stress reduction and mindfulness-based cognitive therapy may be helpful to address a wide range of difficulties in MS.Specific adaptations may be needed to deliver suitable therapies to people with MS.Additional research is warranted to build on preliminary findings for DBT and ACT.
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Affiliation(s)
- Nicolò Zarotti
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Fiona Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Annabel Broyd
- University College London Hospitals NHS Trust, London, UK
| | | | - Amanda Mobley
- Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Adherence to Therapy, Physical and Mental Quality of Life in Patients with Multiple Sclerosis. J Pers Med 2021; 11:jpm11070672. [PMID: 34357139 PMCID: PMC8303119 DOI: 10.3390/jpm11070672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Ensuring multiple sclerosis (MS) patients' adherence to therapy is often challenging, but it is crucial to their survival and health-related quality of life (HRQoL). The aim of the present study was to outline connections between adherence, physical and mental HRQoL, levels of psychological readiness to engage in a treatment, levels of social support, anthropometric, socio-demographic and clinical factors in patients suffering from MS. This cross-sectional study involved a sample of 237 Italian MS patients. A survey was conducted with a structured self-administered online questionnaire using validated measures of quality of life, adherence to therapy and anthropometric, socio-demographic, psychological and clinical variables. A path analysis was used to test the overall structure of the associations between the variables. The pathway indicates a positive association between mental health index and a stronger degree of engagement and being or having been in a long-term relationship. Physical health index was positively associated with age, having an occupation, and having a specific form of MS. Having had relapses in the previous year raised the odds of better adherence to therapy, while an increase in Body Mass Index (BMI) reduced them. Our findings could help in the management of MS patients, promoting behavioral interventions that take the psychological and socio-demographic peculiarities of each patient into account with a view to improving their adherence to therapy.
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12
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Khatibi A, Weiland TJ, Dehghani M. Fear of relapse in patients suffering from RRMS influence their quality of life. Mult Scler Relat Disord 2021; 54:103137. [PMID: 34252838 DOI: 10.1016/j.msard.2021.103137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/16/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022]
Abstract
Multiple Sclerosis (MS) is a chronic, potentially debilitating disease that affects millions of patients worldwide. About 85% of patients experience a disease subtype characterised by relapses and remittance (RRMS). While many studies have investigated factors influencing patients'' health-related quality of life (HRQoL) in RRMS, none have taken patients' fear of relapses into account. In this study, we measured the patients' self-reported HRQoL, fear of relapse (FoR), health anxiety (HA), number of relapses, duration of disease, type of medication and perceived level of side effects. Treating neurologists provided an estimate of patients' disease severity. All covariates and demographic (personal and disease-related) characteristics were included in regression modelling of their association with HRQoL. The model showed that HRQoL was most strongly associated with disease severity estimated by neurologists, which was highly correlated with the number of relapses and disease duration. However, upon adjustment for FoR (in the presence of all covariates), this association between disease severity and HRQoL attenuated, and FoR remained the only covariate significantly associated with HRQoL. Notably, our modelling also revealed a significant association between HA and FoR in RRMS patients. This study's findings have important implications for the management of MS in RRMS patients and point to the critical roles of FoR and HA as drivers of HRQoL in RRMS. Given the importance of HRQoL to the patient experience and economically, we argue that a more nuanced understanding is needed of the subjective nature of quality of life and its determinants. Interventions aimed at reducing psychological distress and anxiety should be explored.
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Affiliation(s)
- Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Centre for Human Brain Health, University of Birmingham, Birmingham, UK.
| | - Tracey J Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mohsen Dehghani
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Psychology, Shahid Beheshti University, Tehran, Iran
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Psychological well-being in people with multiple sclerosis and its association with illness perception and self-esteem. Mult Scler Relat Disord 2021; 54:103114. [PMID: 34217996 DOI: 10.1016/j.msard.2021.103114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Illness perception and self-esteem were found to improve adjustment to disease in many chronic conditions. However, so far, little is known about the role of illness-appraisal and self-appraisal factors in psychological well-being in people with multiple sclerosis (MS). Thus, we aimed to assess the association between illness perception, self-esteem and psychological well-being in people with MS while controlling for sociodemographic variables, clinical variables, and sleep-related problems. METHODS The General Health Questionnaire-28, the Brief Illness Perception Questionnaire, the Rosenberg Scale of Self-esteem, the Expanded Disability Status Scale, the Pittsburgh Sleep Quality Index, and the Multidimensional Fatigue Inventory were used. Multiple linear regressions and mediation analyses were utilized to analyse the data. RESULTS Positive illness perception (p<0.001) and self-esteem (p<0.05) were significantly associated with psychological well-being in MS. Low income (p<0.05) and sleep-related problems (p<0.001) were significantly associated with lower level of psychological well-being in people with MS. Positive illness perception and self-esteem were able to diminish the association between low income (p>0.05), poor sleep quality (p<0.01), fatigue (p>0.05), and low level of psychological well-being. Self-esteem also mediated the association between illness perception and psychological well-being. DISCUSSION People with MS may benefit from psychological support aimed at promoting self-esteem and diminishing negative illness perception.
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14
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Sesel AL, Sharpe L, Beadnall HN, Barnett MH, Szabo M, Naismith SL. Development of a Web-Based Mindfulness Program for People With Multiple Sclerosis: Qualitative Co-Design Study. J Med Internet Res 2021; 23:e19309. [PMID: 33650980 PMCID: PMC7967236 DOI: 10.2196/19309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/05/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background Mindfulness-based stress reduction is an efficacious treatment for people with chronic health problems; however, it is highly intensive and time-consuming, which is a barrier for service provision. Objective This study aims to develop an internet-delivered adapted version of mindfulness-based stress reduction for people with multiple sclerosis to make the intervention more accessible. Methods We co-designed a web-based mindfulness program with end users, that is, people with multiple sclerosis (N=19). Iterative feedback was also collected from a subsample of the initial group of end users (n=11), and the program was reviewed by experts (n=8). Results We identified three main themes common to people with multiple sclerosis: dealing with uncertainty and fears for the future, grief and loss, and social isolation. These themes were incorporated into narratives throughout the program. People with multiple sclerosis who reviewed the program gave feedback that the program was relatable, feasible, and acceptable. Experts agreed that the program appropriately represented the main tenets of mindfulness. Iterative feedback was used to further refine the program. Conclusions The web-based mindfulness program that we developed was viewed positively by both experts and end users. The program reflects common concerns for people with multiple sclerosis and has the potential to meet important unmet psychological needs. A randomized controlled trial was planned to determine the efficacy of the program.
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Affiliation(s)
- Amy-Lee Sesel
- School of Psychology, University of Sydney, Sydney, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, Australia
| | - Heidi N Beadnall
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Marianna Szabo
- School of Psychology, University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- School of Psychology, University of Sydney, Sydney, Australia.,Brain and Mind Centre, University of Sydney, Sydney, Australia
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15
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Wallis OC, de Vries J. EMDR treatment for anxiety in MS patients: A pilot study. Mult Scler J Exp Transl Clin 2020; 6:2055217320974388. [PMID: 33447394 PMCID: PMC7780185 DOI: 10.1177/2055217320974388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/25/2020] [Indexed: 02/01/2023] Open
Abstract
Background Patients with multiple sclerosis (MS) often experience high levels of anxiety, specifically about the (unpredictable) future related to MS. Worries about physical and cognitive declines can cause frightening mental representations of future ‘worst-case scenarios’. Evidence of the applicability of eye movement desensitization reprocessing (EMDR) using flash-forward on anxiety is growing. Objective This pilot study examines the flash-forward EMDR procedure as a treatment option in MS patients suffering from anxiety specifically related to future MS problems. Methods Eight MSpatients suffering from anxiety were treated with one to three sessions of EMDR with a flash-forward target. Treatment effects were evaluated with the use of questionnaires on anxiety, depression, worry, cognitive avoidance, and quality of life at three time points: pre-treatment, direct post-treatment, and three-month follow-up. Results Significant improvement was shown post-treatment compared to pre-treatment on anxiety, depression, and worry. In a case series analysis, all but one participant showed a clinically important difference in anxiety. Conclusion Before implementation on a larger scale can be recommended, the value of EMDR with flash forward targets for anxiety in MS need to be further examined. However, the positive results on this pilot can be seen as promising and motivation for future studies.
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Affiliation(s)
- Olga C Wallis
- Department of Medical Psychology, ETZ Hospital, Tilburg, the Netherlands
| | - Jolanda de Vries
- Department of Medical Psychology, ETZ Hospital, Tilburg, the Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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16
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Ochoa-Morales A, Fresan-Orellana A, Hernández-Mojica T, Jara-Prado A, Corona-Vázquez T, Flores-Rivera JJ, Rito-García CY, Rivas-Alonso V, Guerrero-Camacho JL, Dávila-Ortiz de Montellano DJ. Perceived discrimination in patients with multiple sclerosis and depressive symptomatology. Mult Scler Relat Disord 2020; 48:102705. [PMID: 33383366 DOI: 10.1016/j.msard.2020.102705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple Sclerosis is the central nervous system's most common demyelinating disease and the second leading cause of neurological disability in young adults. Its natural development involves physical and cognitive impairment. Patients commonly perceive discrimination against them, regardless of its occurrence, accepting it as an inherent part of the disease. OBJECTIVE This study aimed to determine the association between perceived discrimination and the depressive symptoms and physical disability present in patients diagnosed with multiple sclerosis, treated at the Demyelinating Diseases Clinic of the National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez. METHODS A cross-sectional study was conducted in 98 patients diagnosed with multiple sclerosis. Demographic and clinical variables were obtained through clinical interviews. The severity of the disease was determined using the Extended Disability Status Scale (EDSS), depressive symptoms were assessed with the Beck Depression Inventory (BDI), and perceived discrimination was rated using the King Internalized Stigma Scale. RESULTS The studied sample's mean age was 36.3 years, schooling 13.6 years, symptoms onset was at 26.2 years (with a delay in diagnosis of 3.2 years), and a disease evolution of 10.9 years. 71.4% were single; 52% had an unpaid work activity and 57.1% were women. The EDSS average was 3.5 points; 24.5% presented moderate to severe depressive symptoms and 53.1% referred perceived discrimination. CONCLUSIONS Perceived discrimination in patients with multiple sclerosis was associated with earlier disease onset, depressive symptoms, and the lack of caregivers. Medical care and life quality improvement for this vulnerable group require greater education regarding the disease and the establishment of patient support programs.
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Affiliation(s)
- A Ochoa-Morales
- Genetics Department. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - A Fresan-Orellana
- Clinical Epidemiology Laboratory. Clinical Research Directorate. National Institute of Psychiatry "Ramón de la Fuente Muñiz," Mexico City, Mexico
| | - T Hernández-Mojica
- Genetics Department. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - A Jara-Prado
- Genetics Department. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - T Corona-Vázquez
- Clinical Laboratory of Neurodegenerative Diseases. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - J J Flores-Rivera
- Clinical Laboratory of Neurodegenerative Diseases. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico.; ABC Neurological Center, Mexico City, Mexico
| | - C Y Rito-García
- Clinical Laboratory of Neurodegenerative Diseases. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - V Rivas-Alonso
- Clinical Laboratory of Neurodegenerative Diseases. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - J L Guerrero-Camacho
- Genetics Department. National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
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Reguera-García MM, Liébana-Presa C, Álvarez-Barrio L, Alves Gomes L, Fernández-Martínez E. Physical Activity, Resilience, Sense of Coherence and Coping in People with Multiple Sclerosis in the Situation Derived from COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218202. [PMID: 33172022 PMCID: PMC7664264 DOI: 10.3390/ijerph17218202] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 02/08/2023]
Abstract
The confinement forced by COVID-19 can have repercussions on the health of people diagnosed with multiple sclerosis. The objective of this study is to analyze the relationships between physical activity, a sense of coherence, resilience and coping among people diagnosed with Multiple Sclerosis during the health emergency situation. To achieve this goal, this transversal descriptive study included 84 patients that belonged to multiple sclerosis associations during the period of confinement. Participants filled out the Physical Activity (IPAQ-SF), Sense of Coherence (SOC-13), Resilience Scale (ER-14) and coping (COPE-28) questionnaires. The results showed that the average age was 46.9 and that 67.9% had Relapsing Remittent Multiple Sclerosis diagnosed on average 13.9 years ago. They had a high degree (33.3%) and moderate degree (34.5%) of physical activity, high levels of resilience, while the level of a sense of coherence was average and the most commonly used strategies for coping were active confrontation and religion. Physical activity was not related to the rest of the studied variables, but there were correlations between the other variables. The people with multiple sclerosis who belong to patient associations have remained physically active during the obligatory confinement period and have elevated degrees of resilience and an average sense of coherence, as well as using suitable coping strategies, which is why the social-health resource of belonging to a patient association could be boosting these variables that are beneficial to their health.
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Affiliation(s)
- María Mercedes Reguera-García
- SALBIS Research Group, Faculty of Health Sciences, Campus of Ponferrada, University of León, 24401 Ponferrada, Spain; (M.M.R.-G.); (E.F.-M.)
| | - Cristina Liébana-Presa
- SALBIS Research Group, Faculty of Health Sciences, Campus of Ponferrada, University of León, 24401 Ponferrada, Spain; (M.M.R.-G.); (E.F.-M.)
- Correspondence:
| | - Lorena Álvarez-Barrio
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus of Ponferrada, University of León, 24401 Ponferrada, Spain;
| | | | - Elena Fernández-Martínez
- SALBIS Research Group, Faculty of Health Sciences, Campus of Ponferrada, University of León, 24401 Ponferrada, Spain; (M.M.R.-G.); (E.F.-M.)
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18
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Wallis O, Bol Y, Köhler S, Heugten C. Anxiety in multiple sclerosis is related to depressive symptoms and cognitive complaints. Acta Neurol Scand 2020; 141:212-218. [PMID: 31693750 DOI: 10.1111/ane.13191] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS) patients suffer from high levels of anxiety. However, it is unclear which factors are related to anxiety, since study results are inconsistent, and the associated factors have not been examined comprehensively. In this study, we investigated the demographic, disease-related and psychological factors associated with anxiety in MS patients. MATERIALS AND METHODS Cross-sectional data of 119 MS patients were used. Anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), fatigue (Fatigue Severity Scale), cognitive complaints (Cognitive Failures Questionnaire) and cognitive functioning (Wisconsin Card Sorting Test, Controlled Oral Word Association Test, Letter Digit Substitution Test, Concept Shifting Test, Wechsler Memory Test Faces and the Dutch version of the California Verbal Learning Test) were measured. Bivariate and multivariable regression analyses were conducted to test the associations between anxiety and potential contributing factors. RESULTS In this sample, 42% of the MS patients had clinically significant levels of anxiety, defined by a score ≥8 on the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS). A significant correlation was found between anxiety and depressive symptoms, fatigue, cognitive complaints and psychiatric history. In the multivariable analysis, only depressive symptoms and cognitive complaints remained significantly related to anxiety. CONCLUSIONS Anxiety is common in MS patients and most strongly related to psychological factors. This knowledge can be taken into account when treating patients with MS. Further research is needed using longitudinal designs and incorporating other factors known to influence anxiety, such as coping, negative affectivity and social support.
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Affiliation(s)
- Olga Wallis
- Department of Medical Psychology ETZ Hospital Tilburg The Netherlands
| | - Yvonne Bol
- Department of Clinical and Medical Psychology Zuyderland Medical Center Sittard‐Geleen The Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience Maastricht University Medical Center Maastricht The Netherlands
| | - Caroline Heugten
- School for Mental Health and Neuroscience Maastricht University Medical Center Maastricht The Netherlands
- Department of Neuropsychology and Psychopharmacology Maastricht University Maastricht The Netherlands
- Brain Injury Center Limburg Maastricht The Netherlands
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19
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Silveira C, Guedes R, Maia D, Curral R, Coelho R. Neuropsychiatric Symptoms of Multiple Sclerosis: State of the Art. Psychiatry Investig 2019; 16:877-888. [PMID: 31805761 PMCID: PMC6933139 DOI: 10.30773/pi.2019.0106] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 10/07/2019] [Indexed: 12/13/2022] Open
Abstract
Multiple Sclerosis (MS) is a chronic disabling neuroinflammatory disease. Psychiatric manifestations have a high prevalence in MS patients and may worsen the illness progression and the patients' quality of life (QoL). Depression is a highly prevalent condition in MS patients, associated with poorer adherence to treatment, decreased functional status and QoL, and increased suicide risk. Diagnosis and treatment of this disorder is challenging because of symptom overlap. Other prevalent psychiatric comorbidities are anxiety disorders, bipolar disorder, psychotic disorders, substance misuse and personality disorders. As the illness progresses, personality changes can happen, as well as affect abnormalities. Cognitive changes occur frequently in MS patients, and affect features like processing speed, attention, learning, memory, visual spatial capabilities, and some language deficits. Disease-modifying treatments may reduce cognitive impairment because of their container action on the brain's lesion burden. Other QoL determinants such as fatigue, pain, sexual dysfunction, exercise, resilience and social support should be taken into account, in order to promote the individuals' well-being. Further studies are needed in order to elucidate the effectiveness of pharmacotherapy and more neuroimaging studies are required to clarify the relationship between structural changes and psychiatric comorbidities.
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Affiliation(s)
- Celeste Silveira
- Psychiatry Service, Psychiatry and Mental Health Clinic of São João University Hospital Center, Oporto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Oporto, Oporto, Portugal
| | - Renato Guedes
- Psychiatry Service, Psychiatry and Mental Health Clinic of São João University Hospital Center, Oporto, Portugal
| | - Diana Maia
- Psychiatry Service, Psychiatry and Mental Health Clinic of São João University Hospital Center, Oporto, Portugal
| | - Rosário Curral
- Psychiatry Service, Psychiatry and Mental Health Clinic of São João University Hospital Center, Oporto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Oporto, Oporto, Portugal
| | - Rui Coelho
- Psychiatry Service, Psychiatry and Mental Health Clinic of São João University Hospital Center, Oporto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Oporto, Oporto, Portugal
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20
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Ochoa-Morales A, Hernández-Mojica T, Paz-Rodríguez F, Jara-Prado A, Trujillo-De Los Santos Z, Sánchez-Guzmán MA, Guerrero-Camacho JL, Corona-Vázquez T, Flores J, Camacho-Molina A, Rivas-Alonso V, Dávila-Ortiz de Montellano DJ. Quality of life in patients with multiple sclerosis and its association with depressive symptoms and physical disability. Mult Scler Relat Disord 2019; 36:101386. [PMID: 31520986 DOI: 10.1016/j.msard.2019.101386] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/16/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this work was to evaluate the quality of life of patients with multiple sclerosis and its association with depressive symptoms and physical health. METHOD A total of 117 patients clinically diagnosed with Multiple Sclerosis (MS) were studied. The MSQOL-54 scale was applied. The depressive symptoms were assessed using the Beck Depression Inventory (BDI), while degree of physical disability was evaluated with the EDSS (Expanded Disability Status Scale). The results of these last two instruments were associated with MSQOL-54 to determine its influence on the perception of quality of life. RESULTS We evaluated 65 women (56%) and 52 men (44%), with a mean age of 35 years, a mean age of 27 years at the time of diagnosis, and a mean evolution of 8 years. 88% of the patients showed the relapsing-remitting subtype; 42% had paid employment; 29% of the studied patients required help to perform daily activities; 75% took disease-modifying medications. They obtained on average a score of 3.62 ± 2.30 on the EDSS and 11.5 ± 9.21 on the BDI. The general average in MSQOL-54 was 64.67 ± 17.52. CONCLUSIONS Quality of life, in patients with multiple sclerosis is an issue that worries health personnel, it is essential to implement strategies for reducing the impact of the disease on patients' lives, mainly through the application of programs aimed to decrees depression and improve social support.
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Affiliation(s)
- A Ochoa-Morales
- Department of Genetics, National Institute of Neurology and Neurosurgery MVS, Insurgentes Sur 3877 Col, La Fama, Tlalpan 14269 CDMX, Mexico
| | - T Hernández-Mojica
- Department of Genetics, National Institute of Neurology and Neurosurgery MVS, Insurgentes Sur 3877 Col, La Fama, Tlalpan 14269 CDMX, Mexico
| | - F Paz-Rodríguez
- Department of Neuropsychology, National Institute of Neurology and Neurosurgery MVS, Mexico
| | - A Jara-Prado
- Department of Genetics, National Institute of Neurology and Neurosurgery MVS, Insurgentes Sur 3877 Col, La Fama, Tlalpan 14269 CDMX, Mexico
| | | | - M A Sánchez-Guzmán
- Violence Research Laboratory, National Institute of Neurology and Neurosurgery MVS, Mexico
| | - J L Guerrero-Camacho
- Department of Genetics, National Institute of Neurology and Neurosurgery MVS, Insurgentes Sur 3877 Col, La Fama, Tlalpan 14269 CDMX, Mexico
| | - T Corona-Vázquez
- Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery MVS, Mexico
| | - J Flores
- Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery MVS, Mexico; ABC Neurological center, Mexico
| | - A Camacho-Molina
- Department of Genetics, National Institute of Neurology and Neurosurgery MVS, Insurgentes Sur 3877 Col, La Fama, Tlalpan 14269 CDMX, Mexico
| | - V Rivas-Alonso
- Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery MVS, Mexico
| | - D J Dávila-Ortiz de Montellano
- Department of Genetics, National Institute of Neurology and Neurosurgery MVS, Insurgentes Sur 3877 Col, La Fama, Tlalpan 14269 CDMX, Mexico.
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21
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Malygin VL, Boyko AN, Konovalova OE, Pahtusova EE, Dumbrova EV, Tishina IA, Malygin YV. [Anxiety and depressive psychopathological characteristics of patients with multiple sclerosis at different stages of disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:58-63. [PMID: 31156243 DOI: 10.17116/jnevro20191192258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To study the development of anxiety and depressive disorders in patients with exacerbated multiple sclerosis (MS). MATERIAL AND METHODS Forty-three patients with MS were included in the study (women 74.4%, mean age 33.1 years old). SCL-90-R and MASQ questionnaire were used to evaluate psychopathological symptoms. RESULTS AND CONCLUSION There is the high prevalence of symptoms of anxiety and depression in patients with MS. Other symptoms, including interpersonal sensitivity, hostility and decrease of stress response, are observed as well.
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Affiliation(s)
- V L Malygin
- Evdokimov Moscow State University of Medical Dentistry, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O E Konovalova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E E Pahtusova
- Evdokimov Moscow State University of Medical Dentistry, Moscow, Russia
| | - E V Dumbrova
- Evdokimov Moscow State University of Medical Dentistry, Moscow, Russia
| | - I A Tishina
- Evdokimov Moscow State University of Medical Dentistry, Moscow, Russia
| | - Ya V Malygin
- Pirogov Russian National Research Medical University, Moscow, Russia
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Hegedüs K, Kárpáti J, Iljicsov A, Simó M. Neuropsychological characteristics of benign multiple sclerosis patients: A two-year matched cohort study. Mult Scler Relat Disord 2019; 35:150-155. [PMID: 31376686 DOI: 10.1016/j.msard.2019.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/19/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The definition of benign multiple sclerosis (BMS) is still debated. It is mainly based on physical status, however, there is an attempt to involve cognitive functioning or paraclinical factors in order to avoid unnecessary long-term treatment with disease-modifying therapies and to identify these subjects in the early stages of the disease. Therefore the aim of our two-year follow-up study was to investigate the pattern of cognitive functioning and depression in patients with BMS compared to treated relapsing-remitting MS (RRMS) patients and healthy controls. METHODS A group of 22 BMS patients was tested against matched RRMS patients and healthy controls. All individuals underwent neuropsychological evaluation exploring mood and the cognitive domains most frequently impaired in MS. MS patients were retested at two-year follow-up. RESULTS In terms of cognitive functions there were no differences between BMS and RRMS patients either at baseline or at two-year follow-up. Compared to healthy controls BMS patients showed poorer performance in long-term visuo-spatial memory and information processing speed, whereas, complex attention, working memory, long-term verbal memory - despite slower verbal learning - and executive function were found to be intact. RRMS patients showed significant difference in complex attention, long-term visual memory and information processing speed. Cognitive impairment differed in the patient groups in terms of severity. Both patient groups were depressed compared to controls, but significant differences were found only between BMS and healthy individuals. CONCLUSION The results of our study confirm that cognitive functions and mood can be affected in MS independent of disease course and disease modifying treatment. The "benign" label should be treated as only a reference to physical status and non-motor symptoms should be routinely monitored. Without receiving therapy it is an existing entity with longstanding minimal disability.
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Affiliation(s)
- Katalin Hegedüs
- Department of Neurology, Semmelweis University, Balassa J. u. 6., 1083 Budapest, Hungary.
| | - Judit Kárpáti
- Department of Neurology, Semmelweis University, Balassa J. u. 6., 1083 Budapest, Hungary
| | - Anna Iljicsov
- Department of Neurology, Semmelweis University, Balassa J. u. 6., 1083 Budapest, Hungary
| | - Magdolna Simó
- Department of Neurology, Semmelweis University, Balassa J. u. 6., 1083 Budapest, Hungary
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23
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Psychiatric disorders in multiple sclerosis. J Neurol 2019; 268:45-60. [PMID: 31197511 DOI: 10.1007/s00415-019-09426-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is characterized by a large spectrum of symptoms, involving all functional systems. Psychiatric symptoms are common in people with MS (pwMS) having an important impact on quality of life and on some features of MS (fatigue, sleep, disability, adherence to disease-modifying drugs). The main psychiatric disturbances in MS are depressive, bipolar, anxiety, schizophrenic and obsessive-compulsive syndromes. METHODS Literature search for original articles and review in the databases, including PubMed and Scopus from 1959 to 2019. RESULTS AND CONCLUSION Studies answering the aim of this review were selected and reported. Epidemiological and clinical aspects of psychiatric syndromes (PS) in MS as well as self-report diagnostic scales and radiological correlates of PS in MS are described. Moreover, some radiological studies about primary psychiatric disorders (PD) are reported to underline how gray matter atrophy, white matter abnormalities and corpus callosum involvement in these diseases, as features in common with MS, may explain the more frequent occurrence of PD in MS than in the general population.
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Moral Judgment: An Overlooked Deficient Domain in Multiple Sclerosis? Behav Sci (Basel) 2018; 8:bs8110105. [PMID: 30453483 PMCID: PMC6262463 DOI: 10.3390/bs8110105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/02/2018] [Accepted: 11/13/2018] [Indexed: 12/17/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system through which patients can suffer from sensory, motor, cerebellar, emotional, and cognitive symptoms. Although cognitive and behavioral dysfunctions are frequently encountered in MS patients, they have previously received little attention. Among the most frequently impaired cognitive domains are attention, information processing speed, and working memory, which have been extensively addressed in this population. However, less emphasis has been placed on other domains like moral judgment. The latter is a complex cognitive sphere that implies the individuals’ ability to judge others’ actions and relies on numerous affective and cognitive processes. Moral cognition is crucial for healthy and adequate interpersonal relationships, and its alteration might have drastic impacts on patients’ quality of life. This work aims to analyze the studies that have addressed moral cognition in MS. Only three works have previously addressed moral judgement in this clinical population compared to healthy controls, and none included neuroimaging or physiological measures. Although scarce, the available data suggest a complex pattern of moral judgments that deviate from normal response. This finding was accompanied by socio-emotional and cognitive deficits. Only preliminary data are available on moral cognition in MS, and its neurobiological foundations are still needing to be explored. Future studies would benefit from combining moral cognitive measures with comprehensive neuropsychological batteries and neuroimaging/neurophysiological modalities (e.g., functional magnetic resonance imaging, tractography, evoked potentials, electroencephalography) aiming to decipher the neural underpinning of moral judgement deficits and subsequently conceive potential interventions in MS patients.
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Taylor KL, Simpson S, Jelinek GA, Neate SL, De Livera AM, Brown CR, O'Kearney E, Marck CH, Weiland TJ. Longitudinal Associations of Modifiable Lifestyle Factors With Positive Depression-Screen Over 2.5-Years in an International Cohort of People Living With Multiple Sclerosis. Front Psychiatry 2018; 9:526. [PMID: 30425659 PMCID: PMC6218592 DOI: 10.3389/fpsyt.2018.00526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Depression is common and has a significant impact on quality of life for many people with multiple sclerosis (MS). A preventive management approach via modification of lifestyle risk factors holds potential benefits. We examined the relationship between modifiable lifestyle factors and depression risk and the change in depression over 2.5 years. Methods: Sample recruited using online platforms. 2,224 (88.9%) at baseline and 1,309 (93.4%) at 2.5 years follow up completed the necessary survey data. Depression risk was measured by the Patient Health Questionnaire-2 (PHQ-2) at baseline and Patient Health Questionniare-9 (PHQ-9) at 2.5-years follow-up. Multivariable regression models assessed the relationships between lifestyle factors and depression risk, adjusted for sex, age, fatigue, disability, antidepressant medication use, and baseline depression score, as appropriate. Results: The prevalence of depression risk at 2.5-years follow-up in this cohort was 14.5% using the PHQ-2 and 21.7% using the PHQ-9. Moderate alcohol intake, being a non-smoker, diet quality, no meat or dairy intake, vitamin D supplementation, omega 3 supplement use, regular exercise, and meditation at baseline were associated with lower frequencies of positive depression-screen 2.5 years later. Moderate alcohol intake was associated with greater likelihood of becoming depression-free and a lower likelihood of becoming depressed at 2.5-years follow-up. Meditating at least once a week was associated with a decreased frequency of losing depression risk, against our expectation. After adjusting for potential confounders, smoking, diet, physical activity, and vitamin D and omega-3 supplementation were not associated with a change in risk for depression. Conclusion: In a large prospective cohort study of people with MS and depression, in line with the emerging treatment paradigm of early intervention, these results suggest a role for some lifestyle factors in depression risk. Further studies should endeavor to explore the impact of positive lifestyle change and improving depression in people living with MS.
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Affiliation(s)
- Keryn L. Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Department of Psychiatry and Psychosocial Cancer Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Steve Simpson
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Sandra L. Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Emily O'Kearney
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Claudia H. Marck
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Tracey J. Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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Henry A, Tourbah A, Camus G, Deschamps R, Mailhan L, Castex C, Gout O, Montreuil M. Anxiety and depression in patients with multiple sclerosis: The mediating effects of perceived social support. Mult Scler Relat Disord 2018; 27:46-51. [PMID: 30317070 DOI: 10.1016/j.msard.2018.09.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/11/2018] [Accepted: 09/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social support has been identified as a buffering or intervening variable in stressful life events. Research has demonstrated that greater social support is associated with better mental health in multiple sclerosis (MS), but little is known about its links to specific aspects of mental health. We therefore investigated if and how perceived social support modulates depression, anxiety and fatigue in patients with MS. METHODS We recruited 112 patients with MS from three French hospitals and administered a demographic and clinic interview, and self-report measures of perceived social support (Multidimensional Scale of Perceived Social Support), depression and anxiety (Hospital Anxiety and Depression Scale), and fatigue (Fatigue Severity Scale). We then analyzed the relationships between these domains using path analysis. RESULTS The causal path model provided an excellent fit for the data (χ2 = 9.8, p = .778, standardized root mean square residual = 0.043, comparative fit index = 1.00). Results indicated that the level of social support from friends is a predictor of anxiety symptomatology. Thus, anxiety may have both a direct and an indirect impact on fatigue and depression levels. CONCLUSIONS This study highlights the important roles played by perceived social support and anxiety in MS. These should be key pharmacological and non-pharmacological targets for optimizing patient care. (NCT 02-880-553).
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Affiliation(s)
- Audrey Henry
- Cognition, Health and Society Laboratory, University of Reims Champagne-Ardenne, B.P. 30, 57 Rue Pierre Taittinger, 51571 Reims Cedex, France; Psychopathology and Neuropsychology Laboratory, University of Paris 8, 2 rue de la liberté, 93526 Saint-Denis, France.
| | - Ayman Tourbah
- Psychopathology and Neuropsychology Laboratory, University of Paris 8, 2 rue de la liberté, 93526 Saint-Denis, France; Reims University Hospital and Reims Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | - Gauthier Camus
- Cognition, Health and Society Laboratory, University of Reims Champagne-Ardenne, B.P. 30, 57 Rue Pierre Taittinger, 51571 Reims Cedex, France
| | - Romain Deschamps
- Adolphe de Rothschild Ophthalmology Foundation, 29 rue Manin, 75019 Paris, France
| | - Laurence Mailhan
- Porte Verte Hospital, Boulevard de la Porte Verte, 78000 Versailles, France
| | - Cédric Castex
- Reims University Hospital and Reims Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.
| | - Olivier Gout
- Adolphe de Rothschild Ophthalmology Foundation, 29 rue Manin, 75019 Paris, France
| | - Michèle Montreuil
- Psychopathology and Neuropsychology Laboratory, University of Paris 8, 2 rue de la liberté, 93526 Saint-Denis, France
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Bonino S, Graziano F, Borghi M, Marengo D, Molinengo G, Calandri E. The Self-Efficacy in Multiple Sclerosis (SEMS) Scale. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2018. [DOI: 10.1027/1015-5759/a000350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. This research developed a new scale to evaluate Self-Efficacy in Multiple Sclerosis (SEMS). The aim of this study was to investigate dimensionality, item functioning, measurement invariance, and concurrent validity of the SEMS scale. Data were collected from 203 multiple sclerosis (MS) patients (mean age, 39.5 years; 66% women; 95% having a relapsing remitting form of MS). Fifteen items of the SEMS scale were submitted to patients along with measures of psychological well-being, sense of coherence, depression, and coping strategies. Data underwent Rasch analysis and correlation analysis. Rasch analysis indicates the SEMS as a multidimensional construct characterized by two correlated dimensions: goal setting and symptom management, with satisfactory reliability coefficients. Overall, the 15 items reported acceptable fit statistics; the scale demonstrated measurement invariance (with respect to gender and disease duration) and good concurrent validity (positive correlations with psychological well-being, sense of coherence, and coping strategies and negative correlations with depression). Preliminary evidence suggests that SEMS is a psychometrically sound measure to evaluate perceived self-efficacy of MS patients with moderate disability, and it would be a valuable instrument for both research and clinical applications.
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Affiliation(s)
- Silvia Bonino
- Cosso Foundation, Pinerolo, Torino, Italy
- Department of Psychology, University of Torino, Italy
| | | | - Martina Borghi
- Cosso Foundation, Pinerolo, Torino, Italy
- Neurology 2 – CRESM (Regional Reference Centre for Multiple Sclerosis) – “San Luigi Gonzaga” Hospital, Orbassano, Torino, Italy
| | | | - Giorgia Molinengo
- Department of Social Sciences and Humanities, University of Aosta Valley, Torino, Italy
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Young adults' adjustment to a recent diagnosis of multiple sclerosis: The role of identity satisfaction and self-efficacy. Disabil Health J 2018; 12:72-78. [PMID: 30093321 DOI: 10.1016/j.dhjo.2018.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/04/2018] [Accepted: 07/26/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although multiple sclerosis (MS) is often diagnosed during young adulthood (18-30 years), there is a lack of knowledge on the psychological adjustment to the illness among recently diagnosed young adult patients. OBJECTIVE/HYPOTHESIS The aims of the study were to describe the adjustment to MS (depression, positive and negative affect) in a group of young adult patients and to investigate the role of identity satisfaction and self-efficacy in MS on adjustment. We hypothesized that the relationship between identity satisfaction and adjustment was mediated by self-efficacy (goal setting and symptom management). METHODS The cross-sectional study involved 66 patients (63.6% women) with a mean age of 25.2 years (SD = 3.4) who had been diagnosed for no more than three years. Patients completed measures of identity satisfaction (Identity Motives Scale), Self-efficacy in MS (SEMS), Depression (CESD-10), Positive and Negative Affect (PANAS). Data were analyzed through factorial ANOVAs and hierarchical regression analysis. RESULTS Thirty-eight percent of patients reported depressive symptoms and negative affect mean score was higher than in the general population. Higher identity satisfaction was directly related to lower depression. Self-efficacy in goal setting partially mediated the relationship between identity satisfaction and positive affect, whereas self-efficacy in symptom management totally mediated the effect of identity satisfaction on negative affect. All results were significant at p < 0.05. CONCLUSIONS The results suggest the usefulness of addressing identity redefinition and self-efficacy in psychological interventions aimed at promoting young adults' adjustment to MS in an early phase of the illness.
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Raggi A, Giovannetti AM, Schiavolin S, Brambilla L, Brenna G, Confalonieri PA, Cortese F, Frangiamore R, Leonardi M, Mantegazza RE, Moscatelli M, Ponzio M, Torri Clerici V, Zaratin P, De Torres L. Older age, higher perceived disability and depressive symptoms predict the amount and severity of work-related difficulties in persons with multiple sclerosis. Disabil Rehabil 2018; 41:2255-2263. [PMID: 29658343 DOI: 10.1080/09638288.2018.1461937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: This cross-sectional study aims to identify the predictors of work-related difficulties in a sample of employed persons with multiple sclerosis as addressed with the Multiple Sclerosis Questionnaire for Job Difficulties. Materials and methods: Hierarchical linear regression analysis was conducted to identify predictors of work difficulties: predictors included demographic variables (age, formal education), disease duration and severity, perceived disability and psychological variables (cognitive dysfunction, depression and anxiety). The targets were the questionnaire's overall score and its six subscales. Results: A total of 177 participants (108 females, aged 21-63) were recruited. Age, perceived disability and depression were direct and significant predictors of the questionnaire total score, and the final model explained 43.7% of its variation. The models built on the questionnaire's subscales show that perceived disability and depression were direct and significant predictors of most of its subscales. Conclusions: Our results show that, among patients with multiple sclerosis, those who were older, with higher perceived disability and higher depression symptoms have more and more severe work-related difficulties. The Multiple Sclerosis Questionnaire for Job Difficulties can be fruitfully exploited to plan tailored actions to limit the likelihood of near-future job loss in persons of working age with multiple sclerosis. Implications for rehabilitation Difficulties with work are common among people with multiple sclerosis and are usually addressed in terms of unemployment or job loss. The Multiple Sclerosis Questionnaire for Job Difficulties is a disease-specific questionnaire developed to address the amount and severity of work-related difficulties. We found that work-related difficulties were associated to older age, higher perceived disability and depressive symptoms. Mental health issues and perceived disability should be consistently included in future research targeting work-related difficulties.
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Affiliation(s)
- Alberto Raggi
- a Neurology, Public Health and Disability Unit , Neurological Instiute C. Besta, IRCCS Foundation , Milan , Italy
| | - Ambra Mara Giovannetti
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy.,c Unit of Neuroepidemiology , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Silvia Schiavolin
- a Neurology, Public Health and Disability Unit , Neurological Instiute C. Besta, IRCCS Foundation , Milan , Italy
| | - Laura Brambilla
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Greta Brenna
- d Scientific Directorate, Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Paolo Agostino Confalonieri
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Francesca Cortese
- d Scientific Directorate, Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Rita Frangiamore
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Matilde Leonardi
- a Neurology, Public Health and Disability Unit , Neurological Instiute C. Besta, IRCCS Foundation , Milan , Italy
| | - Renato Emilio Mantegazza
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Marco Moscatelli
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Michela Ponzio
- e Scientific Research Area, Italian Foundation of Multiple Sclerosis , Genoa , Italy
| | - Valentina Torri Clerici
- b Department of Neuroimmunology and Neuromuscular Diseases , Neurological Institute C. Besta, IRCCS Foundation , Milan , Italy
| | - Paola Zaratin
- e Scientific Research Area, Italian Foundation of Multiple Sclerosis , Genoa , Italy
| | - Laura De Torres
- a Neurology, Public Health and Disability Unit , Neurological Instiute C. Besta, IRCCS Foundation , Milan , Italy
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30
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Goodwin RA, Lincoln NB, das Nair R, Bateman A. Evaluation of NeuroPage as a memory aid for people with multiple sclerosis: A randomised controlled trial. Neuropsychol Rehabil 2018; 30:15-31. [PMID: 29557731 DOI: 10.1080/09602011.2018.1447973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Memory problems are reported in 40%-60% of people with multiple sclerosis (MS). These problems affect independence and may limit the ability to benefit from rehabilitation. Our aim was to evaluate the effectiveness of NeuroPage for people with MS living in the community. A multicentre, single-blind, randomised controlled crossover trial was conducted. The intervention comprised the NeuroPage service, which sends reminder messages to mobile phones at pre-arranged times. In the control condition participants received "non-memory texts", that is, messages not aimed at providing a reminder; for example, supplying news headlines or sport updates. Outcome measures were completed using postal questionnaires after each condition. There were 38 participants aged 28 to 72 (mean 48, SD 11) and 10 (26%) were men. There were no significant differences between NeuroPage and control conditions on the Everyday Memory Questionnaire (p = 0.41, d = 0.02). The number of daily diary items forgotten in the NeuroPage condition was significantly less than in the control (9% vs. 31%, p = 0.01, d = -0.64). Psychological distress was less in the NeuroPage condition than control (p = 0.001, d = -0.84). Further evaluation of the effect on everyday memory is required.
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Affiliation(s)
- Rachel A Goodwin
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK.,The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Princess of Wales Hospital, Ely, UK
| | - Nadina B Lincoln
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Roshan das Nair
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK.,Division of Psychiatry & Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, UK
| | - Andrew Bateman
- The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Princess of Wales Hospital, Ely, UK
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31
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Chalah MA, Ayache SS. Alexithymia in multiple sclerosis: A systematic review of literature. Neuropsychologia 2017; 104:31-47. [DOI: 10.1016/j.neuropsychologia.2017.07.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/28/2017] [Accepted: 07/29/2017] [Indexed: 02/07/2023]
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Rossi S, Studer V, Motta C, Polidoro S, Perugini J, Macchiarulo G, Giovannetti AM, Pareja-Gutierrez L, Calò A, Colonna I, Furlan R, Martino G, Centonze D. Neuroinflammation drives anxiety and depression in relapsing-remitting multiple sclerosis. Neurology 2017; 89:1338-1347. [DOI: 10.1212/wnl.0000000000004411] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/13/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To explore the inflammatory processes in the pathogenesis of psychiatric symptoms and the prognostic value of psychiatric comorbidities in multiple sclerosis (MS).Methods:Four hundred five patients with relapsing-remitting (RR) MS underwent psychiatric evaluation by means of Beck Depression Inventory II (BDI-II) and State/Trait Anxiety Inventory (STAI-Y). The inflammatory activity level was assessed by MRI. In a subset of 111 treatment-naive patients, CSF levels of proinflammatory cytokines were determined. Correlation and regression analyses were performed to determine associations between variables.Results:Relapsing patients demonstrated greater values of STAI-state and BDI-II compared with remitting patients but comparable trait-anxiety scores. There were no significant differences in psychometric parameters between relapsing and asymptomatic MRI-active patients, highlighting the effect of subclinical inflammation on mood disturbances. A significant reduction of STAI-state and BDI-II scores was recorded, along with the subsiding of neuroinflammation. Interleukin-2 CSF levels were found to correlate with STAI-state, while tumor necrosis factor-α and interleukin-1β correlated with BDI-II. Because emotional disorders were associated with subclinical inflammation, variations of the psychometric profile were able to detect subclinical reactivation earlier. In line with this, high STAI-state values considerably predicted the possibility of disease reactivation.Conclusions:Mood alterations are induced by intrathecal inflammation, even though not clinically apparent, and are able to predict inflammatory reactivations in RRMS. Inflammation is therefore a biological event, not less important than the traditional psychosocial factors, involved in mood disorders.
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Murphy R, O'Donoghue S, Counihan T, McDonald C, Calabresi PA, Ahmed MA, Kaplin A, Hallahan B. Neuropsychiatric syndromes of multiple sclerosis. J Neurol Neurosurg Psychiatry 2017; 88:697-708. [PMID: 28285265 DOI: 10.1136/jnnp-2016-315367] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 01/13/2023]
Abstract
Neuropsychiatric signs and symptoms occur frequently in individuals with multiple sclerosis (MS), either as the initial presenting complaint prior to a definitive neurological diagnosis or more commonly with disease progression. However, the pathogenesis of these comorbid conditions remains unclear and it remains difficult to accurately elucidate if neuropsychiatric symptoms or conditions are indicators of MS illness severity. Furthermore, both the disease process and the treatments of MS can adversely impact an individual's mental health. In this review, we discuss the common neuropsychiatric syndromes that occur in MS and describe the clinical symptoms, aetiology, neuroimaging findings and management strategies for these conditions.
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Affiliation(s)
- Ruth Murphy
- Department of Psychiatry, University College Hospital Galway, Galway, Ireland
| | - Stefani O'Donoghue
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Timothy Counihan
- Department of Neurology, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mohammed As Ahmed
- Departments of Medical Education and Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Adam Kaplin
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brian Hallahan
- Department of Psychiatry, National University of Ireland, Galway, Ireland
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Lincoln NB, Yuill F, Holmes J, Drummond AER, Constantinescu CS, Armstrong S, Phillips C. Evaluation of an adjustment group forpeople with multiple sclerosis and lowmood: a randomized controlled trial. Mult Scler 2017; 17:1250-7. [DOI: 10.1177/1352458511408753] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Mood problems affect many people with multiple sclerosis (MS). The aim was to evaluate the effectiveness of a group treatment based on cognitive behavioural principles. Methods: People with MS were screened on the General Health Questionnaire 12 (GHQ-12) and Hospital Anxiety and Depression Scale (HAD). Those identified with low mood were invited to take part in a randomized trial comparing the effect of attending an adjustment group with a waiting list control. Patients allocated to the adjustment group received six 2 h group treatment sessions. Outcomes were assessed 4 and 8 months after randomization, blind to group allocation. Results: Of the 311 patients identified, 221 (71%) met the criteria for low mood and 151 (68%) agreed to take part. Hierarchical regression analyses were conducted to compare the two groups, correcting for baseline mood and disability. At 4 months, group allocation alone was a significant predictor of the primary outcome measure, the GHQ-12. At 8 months, group allocation alone was no longer a significant predictor for GHQ-12 scores, but it was when baseline GHQ-12 and Guy’s Neurological Disability Scale scores were controlled for. Comparison of the area under the curve revealed significant differences between the groups for GHQ-12 ( p = 0.003), HAD Anxiety ( p = 0.013), HAD Depression ( p = 0.004), Beck Depression Inventory ( p = 0.001), MS Self-efficacy ( p = 0.037) and MS Impact Scale Psychological ( p = 0.012). Conclusion: Patients receiving treatment were less distressed and had less depression and anxiety. There was some evidence of improved self-efficacy and a reduction of the impact of MS on people’s lives.
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Affiliation(s)
- Nadina B Lincoln
- Institute of Work, Health and Organisations, University of Nottingham, UK
| | - Faye Yuill
- Institute of Work, Health and Organisations, University of Nottingham, UK
| | - Jessica Holmes
- Institute of Work, Health and Organisations, University of Nottingham, UK
| | | | | | - Sarah Armstrong
- Trent Research and Development Support Unit, University of Nottingham, UK
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Borghi M, Bonino S, Graziano F, Calandri E. Exploring change in a group-based psychological intervention for multiple sclerosis patients. Disabil Rehabil 2017; 40:1671-1678. [PMID: 28355925 DOI: 10.1080/09638288.2017.1306588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The study is focused on a group-based cognitive behavioral intervention aimed at promoting the quality of life and psychological well-being of multiple sclerosis patients. The study investigates how the group intervention promoted change among participants and fostered their adjustment to the illness. MATERIALS AND METHODS The intervention involved six groups of patients (a total of 41 patients) and included four consecutive sessions and a 6-month follow-up. To explore change, verbatim transcripts of the intervention sessions were analyzed using a mixed-methods content analysis with qualitative data combined with descriptive statistics. The categories of resistance and openness to change were used to describe the process of change. RESULTS Resistance and openness to change coexisted during the intervention. Only in the first session did resistance prevail over openness to change; thereafter, openness to change gradually increased and stabilized over time, and openness to change was then always stronger than resistance. CONCLUSIONS The study builds on previous research on the effectiveness of group-based psychological interventions for multiple sclerosis patients and gives methodological and clinical suggestions to health care professionals working with multiple sclerosis patients. Implications for rehabilitation The study suggests that a group-based cognitive behavioral intervention for multiple sclerosis patients focused on the promotion of identity redefinition, a sense of coherence and self-efficacy in dealing with multiple sclerosis fosters the process of change and may be effective in promoting patients' adjustment to their illness. Health care professionals leading group-based psychological interventions for multiple sclerosis patients should be aware that resistance and openness to change coexist in the process of change. The study suggests that the duration of the intervention is a crucial factor: a minimum of three sessions appears to be necessary for group participants to develop greater openness to change and follow-up sessions should be implemented to maintain positive changes among participants. The use of qualitative instruments to evaluate group interventions captures the complexity of processes and gives useful indications to health professionals to improve rehabilitation programs.
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Affiliation(s)
- Martina Borghi
- a Regional Referral Multiple Sclerosis Centre (CRESM) - 'San Luigi Gonzaga' Hospital , Orbassano , Italy , Torino.,b Cosso Foundation , Pinerolo , Italy , Torino
| | - Silvia Bonino
- b Cosso Foundation , Pinerolo , Italy , Torino.,c Department of Psychology , University of Torino , Italy
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Becker H, Stuifbergen AK, Schnyer RN, Morrison JD, Henneghan A. Integrating Acupuncture Within a Wellness Intervention for Women With Multiple Sclerosis. J Holist Nurs 2016; 35:86-96. [DOI: 10.1177/0898010116644833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This pilot study explored change over time in symptom management, health promotion, and quality of life following exposure to a holistic intervention combining group acupuncture with group sessions about health promotion for women with multiple sclerosis. Design: This was a pre/post nonexperimental design. Method: Fourteen women (average age 54 years) attended eight classes designed to help participants build the skills necessary to improve their health and consequently their overall quality of life. Acupuncture was provided in a group setting either immediately before or after each class. Findings: Self-reported fatigue, stress, pain, depression, anxiety, and sleep interference decreased significantly, and overall health-promoting behaviors, self-efficacy for health promotion, social functioning, and quality of life increased significantly. In addition, focus groups held with the participants indicated that they responded positively to the combination of acupuncture with an efficacy-building health promotion intervention. Conclusions: The results of this pilot study add to the growing literature demonstrating that holistic health promotion interventions may have positive benefits for people with multiple sclerosis. Delivering acupuncture to a small group of individuals attending wellness classes appears to be feasible and was generally well received by the study participants.
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37
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Calandri E, Graziano F, Borghi M, Bonino S. Improving the quality of life and psychological well-being of recently diagnosed multiple sclerosis patients: preliminary evaluation of a group-based cognitive behavioral intervention. Disabil Rehabil 2016; 39:1474-1481. [DOI: 10.1080/09638288.2016.1198430] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Martina Borghi
- Cosso Foundation, Pinerolo, Torino, Italy
- CRESM (Regional Referral Multiple Sclerosis Centre) – “San Luigi Gonzaga” Hospital – Orbassano, Torino, Italy
| | - Silvia Bonino
- Department of Psychology, University of Torino, Torino, Italy
- Cosso Foundation, Pinerolo, Torino, Italy
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38
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Carletto S, Borghi M, Bertino G, Oliva F, Cavallo M, Hofmann A, Zennaro A, Malucchi S, Ostacoli L. Treating Post-traumatic Stress Disorder in Patients with Multiple Sclerosis: A Randomized Controlled Trial Comparing the Efficacy of Eye Movement Desensitization and Reprocessing and Relaxation Therapy. Front Psychol 2016; 7:526. [PMID: 27148134 PMCID: PMC4838623 DOI: 10.3389/fpsyg.2016.00526] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/29/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Multiple Sclerosis (MS) is a demyelinating autoimmune disease that imposes a significant emotional burden with heavy psychosocial consequences. Several studies have investigated the association between MS and mental disorders such as depression and anxiety, and recently researchers have focused also on Post-traumatic Stress Disorder (PTSD). This is the first study that investigates the usefulness of proposing a treatment for PTSD to patients with MS. METHODS A randomized controlled trial with patients with MS diagnosed with PTSD comparing Eye Movement Desensitization and Reprocessing (EMDR; n = 20) and Relaxation Therapy (RT; n = 22). The primary outcome measure was the proportion of participants that no longer meet PTSD diagnosis as measured with Clinician Administered PTSD Scale 6-months after the treatment. RESULTS The majority of patients were able to overcome their PTSD diagnosis after only 10 therapy sessions. EMDR treatment appears to be more effective than RT in reducing the proportion of patients with MS suffering from PTSD. Both treatments are effective in reducing PTSD severity, anxiety and depression symptoms, and to improve Quality of Life. CONCLUSION Although our results can only be considered preliminary, this study suggests that it is essential that PTSD symptoms are detected and that brief and cost-effective interventions to reduce PTSD and associated psychological symptoms are offered to patients, in order to help them to reduce the psychological burden associated with their neurological condition. TRIAL REGISTRATION NCT01743664, https://clinicaltrials.gov/ct2/show/NCT01743664.
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Affiliation(s)
- Sara Carletto
- Clinical Psychology and Psychosomatics Service, University Hospital San Luigi Gonzaga, University of TurinOrbassano, Italy; Clinical and Biological Sciences Department, University Hospital San Luigi Gonzaga, University of TurinOrbassano, Italy
| | - Martina Borghi
- Clinical Psychology and Psychosomatics Service, University Hospital San Luigi Gonzaga, University of TurinOrbassano, Italy; Neurologia 2 - Centro di Riferimento Regionale Sclerosi Multipla, Azienda Ospedaliero-Universitaria San Luigi GonzagaOrbassano, Italy
| | - Gabriella Bertino
- Clinical Psychology and Psychosomatics Service, University Hospital San Luigi Gonzaga, University of Turin Orbassano, Italy
| | - Francesco Oliva
- Clinical and Biological Sciences Department, University Hospital San Luigi Gonzaga, University of Turin Orbassano, Italy
| | - Marco Cavallo
- eCampus UniversityNovedrate (CO,) Italy; Department of Mental Health, Azienda Sanitaria Locale Torino 3Turin, Italy
| | - Arne Hofmann
- Facharzt für Psychosomatische und Innere Medizin, Eye Movement Desensitization and Reprocessing Institut Deutschland Bergisch Gladbach, Germany
| | | | - Simona Malucchi
- Neurologia 2 - Centro di Riferimento Regionale Sclerosi Multipla, Azienda Ospedaliero-Universitaria San Luigi Gonzaga Orbassano, Italy
| | - Luca Ostacoli
- Clinical Psychology and Psychosomatics Service, University Hospital San Luigi Gonzaga, University of TurinOrbassano, Italy; Clinical and Biological Sciences Department, University Hospital San Luigi Gonzaga, University of TurinOrbassano, Italy
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Patil I, Young L, Sinay V, Gleichgerrcht E. Elevated moral condemnation of third-party violations in multiple sclerosis patients. Soc Neurosci 2016; 12:308-329. [DOI: 10.1080/17470919.2016.1175380] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Giovannetti AM, Schiavolin S, Brenna G, Brambilla L, Confalonieri P, Cortese F, Covelli V, Frangiamore R, Leonardi M, Mantegazza R, Moscatelli M, Ponzio M, Torri Clerici V, Zaratin P, Raggi A. Cognitive function alone is a poor predictor of health-related quality of life in employed patients with MS: results from a cross-sectional study. Clin Neuropsychol 2016; 30:201-15. [PMID: 26930374 DOI: 10.1080/13854046.2016.1142614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Depression, anxiety, disease severity, and cognitive functions impact on the quality of life of people with MS. However, the majority of studies were not based on multivariate models and did not target employed patients. The aim of this study was to investigate predictors of HRQoL in persons with MS in the workforce considering cognitive, psychological, disease severity, and disability-related variables. METHODS Cross-sectional study. Hierarchical block regression analyses were conducted to identify predictors of physical and mental components of HRQoL, measured with the MSQOL-54. Candidate predictors included cognitive functioning (a selection of Rao's BRB-NT), sample features (age, education, MS duration), depressive symptoms (BDI-II), anxiety (STAI-Y), disability (WHODAS 2.0), and MS severity (EDSS): those that correlated with PCS and MCS with p < .250 and those that correlated with other predictors with coefficients >.800 were excluded from regression analyses. RESULTS In total, 181 patients (60.8% females, mean age 39.6, median EDSS 1.5) were included. In both models, cognitive variables had a poor explicative power. The models improved significantly when psychological, as well as, disease severity and disability variables were added. R(2) of complete models was 0.732 for the physical component, 0.697 for the mental one: BDI-II, STAI-State and, some WHODAS 2.0 scales were significant predictors of HRQoL. CONCLUSIONS Monitoring anxiety, depressive symptoms, and level of disability through self-reported questionnaires may provide useful suggestions to improve the HRQoL of persons with MS in the workforce, permitting to address possible problems in the work context and plan corrective actions.
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Affiliation(s)
- Ambra Mara Giovannetti
- a Department of Neuroimmunology and Neuromuscolar Disease , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Silvia Schiavolin
- b Neurology, Public Health and Disability Unit , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Greta Brenna
- a Department of Neuroimmunology and Neuromuscolar Disease , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Laura Brambilla
- a Department of Neuroimmunology and Neuromuscolar Disease , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Paolo Confalonieri
- a Department of Neuroimmunology and Neuromuscolar Disease , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Francesca Cortese
- c Scientific Directorate , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Venusia Covelli
- b Neurology, Public Health and Disability Unit , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Rita Frangiamore
- a Department of Neuroimmunology and Neuromuscolar Disease , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Matilde Leonardi
- b Neurology, Public Health and Disability Unit , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Renato Mantegazza
- a Department of Neuroimmunology and Neuromuscolar Disease , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Marco Moscatelli
- a Department of Neuroimmunology and Neuromuscolar Disease , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Michela Ponzio
- d Scientific Research Area , Italian Foundation of Multiple Sclerosis , Genoa , Italy
| | - Valentina Torri Clerici
- a Department of Neuroimmunology and Neuromuscolar Disease , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
| | - Paola Zaratin
- d Scientific Research Area , Italian Foundation of Multiple Sclerosis , Genoa , Italy
| | - Alberto Raggi
- b Neurology, Public Health and Disability Unit , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy
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Abstract
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system leading to physical and cognitive disability. The impact of the disease on social cognition has only come to light quite recently. The aim of this study was to evaluate the social cognition abilities of MS patients and their links with characteristics of the disease, such as physical disability, cognitive impairment and disease duration.The performances of a group of 64 MS patients were compared with that of 30 matched healthy individuals in facial emotion recognition and Faux Pas tasks as well as on a battery of standardized neuropsychological tests.The MS patients performed worse than the control group in the recognition of the expressions of fear and anger and in the interpretation of faux pas. The impairment in social cognition increased with overall disease course. Executive impairment did not correlate with the performance in the social cognition tests.Our results show that emotional impairment is observed at early stages of the disease in the absence of cognitive dysfunction, even if social cognition abilities worsen with the progression of MS. These data highlight the need to attempt to identify these impairments in clinical practice.
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Darviri C, Zavitsanou C, Delikou A, Giotaki A, Artemiadis A, Anagnostouli M, Varvogli L, Vasdekis S, Chrousos GP. Pythagorean Self-Awareness Serves Successfully as a New Cognitive Behavioral-Based Technique in Multiple Sclerosis Physical and Psychosocial Well-Being and Quality of Life. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/psych.2016.74059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cardoso M, Olmo NR, Fragoso YD. Systematic Review of Cognitive Dysfunction in Pediatric and Juvenile Multiple Sclerosis. Pediatr Neurol 2015; 53:287-92. [PMID: 26233264 DOI: 10.1016/j.pediatrneurol.2015.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/21/2015] [Accepted: 06/09/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cognitive dysfunction is a common finding in individuals with multiple sclerosis at all ages. Cognitive impairment may drastically affect the life of younger patients with multiple sclerosis who are still undergoing education and schooling. METHODS We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations to assess the published data on multiple sclerosis and cognition in pediatric or juvenile patients. Only articles presenting original data on patients with multiple sclerosis diagnosed before age 18 years of age were included. RESULTS Thirty-two articles fulfilled the inclusion criteria for this systematic review. The conclusion from all articles was that cognitive dysfunction in multiple sclerosis starting before the age of 18 years is both significant and disruptive and must be routinely assessed. However, assessment methods were heterogeneous and often very expensive to perform, whereas proposals for treatment were virtually absent in the literature. CONCLUSION Cognitive dysfunction can be a significant symptom of multiple sclerosis of early onset, but its impact and management needs to be better assessed. A task force should be created to study and manage cognitive dysfunction in pediatric and juvenile multiple sclerosis.
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Affiliation(s)
- Mariana Cardoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil; Post-graduation in Neurology, Ipemed, Belo Horizonte, Minas Gerais, Brazil; Neuroimmunology Angiocorpore, Santos, São Paulo, Brazil
| | - Neide Regina Olmo
- Department of Neurology, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil
| | - Yara Dadalti Fragoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil; Neuroimmunology Angiocorpore, Santos, São Paulo, Brazil.
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Fischer A, Fischer M, Nicholls RA, Lau S, Poettgen J, Patas K, Heesen C, Gold SM. Diagnostic accuracy for major depression in multiple sclerosis using self-report questionnaires. Brain Behav 2015; 5:e00365. [PMID: 26445703 PMCID: PMC4589811 DOI: 10.1002/brb3.365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/31/2015] [Accepted: 06/07/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Multiple sclerosis and major depressive disorder frequently co-occur but depression often remains undiagnosed in this population. Self-rated depression questionnaires are a good option where clinician-based standardized diagnostics are not feasible. However, there is a paucity of data on diagnostic accuracy of self-report measures for depression in multiple sclerosis (MS). Moreover, head-to-head comparisons of common questionnaires are largely lacking. This could be particularly relevant for high-risk patients with depressive symptoms. Here, we compare the diagnostic accuracy of the Beck Depression Inventory (BDI) and 30-item version of the Inventory of Depressive Symptomatology Self-Rated (IDS-SR30) for major depressive disorder (MSS) against diagnosis by a structured clinical interview. METHODS Patients reporting depressive symptoms completed the BDI, the IDS-SR30 and underwent diagnostic assessment (Mini International Neuropsychiatric Interview, M.I.N.I.). Receiver-Operating Characteristic analyses were performed, providing error estimates and false-positive/negative rates of suggested thresholds. RESULTS Data from n = 31 MS patients were available. BDI and IDS-SR30 total score were significantly correlated (r = 0.82). The IDS-SR30total score, cognitive subscore, and BDI showed excellent to good accuracy (area under the curve (AUC) 0.86, 0.91, and 0.85, respectively). CONCLUSION Both the IDS-SR30 and the BDI are useful to quantify depressive symptoms showing good sensitivity and specificity. The IDS-SR30 cognitive subscale may be useful as a screening tool and to quantify affective/cognitive depressive symptomatology.
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Affiliation(s)
- Anja Fischer
- Department of Health Psychology, King's College London SE1 9RT, London, UK ; Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Marcus Fischer
- Department of Pharmaceutical Chemistry, University of California San Francisco San Francisco, California, 94158
| | - Robert A Nicholls
- Structural Studies Division, MRC Laboratory of Molecular Biology Cambridge, CB2 0QH, UK
| | - Stephanie Lau
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Jana Poettgen
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Kostas Patas
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Christoph Heesen
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Neurology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Stefan M Gold
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Medical Psychology, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin Berlin, Germany
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Théaudin M, Romero K, Feinstein A. In multiple sclerosis anxiety, not depression, is related to gender. Mult Scler 2015; 22:239-44. [DOI: 10.1177/1352458515588582] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/11/2015] [Indexed: 01/21/2023]
Abstract
Background: There is a high prevalence of depressive and anxiety disorders in multiple sclerosis (MS), a disease 2.5 times more frequent in females. Contrary to the general population, in whom studies have demonstrated higher rates of depression and anxiety in females, little is known about the impact of gender on psychiatric sequelae in MS patients. Objectives: We conducted a retrospective study to try to clarify this uncertainty. Methods: Demographic, illness-related and behavioral variables were obtained from a neuropsychiatric database of 896 patients with a confirmed diagnosis of MS. Symptoms of depression and anxiety were obtained with the Hospital Anxiety and Depression Scale (HADS). Gender comparisons were undertaken and predictors of depression and anxiety sought with a linear regression analysis. Results: HADS data were available for 711 of 896 (79.35%) patients. Notable gender differences included a higher frequency of primary progressive MS in males ( p = 0.002), higher HADS anxiety scores in females ( p < 0.001), but no differences in HADS depression scores. Conclusion: In MS, gender influences the frequency of anxiety only. This suggests that the etiological factors underpinning anxiety and depression in MS are not only different from one another, but also in the case of depression, different from those observed in general population samples.
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Affiliation(s)
- Marie Théaudin
- Sunnybrook Health Sciences Centre, Canada/MS Clinic Saint Michael’s Hospital, Canada
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Ozdemir PG, Milanlioglu A, Boysan M, Cilingir V, Aydin N, Atli A. Relations between mood characteristics, circadian preferences, and functionality in multiple sclerosis. Int J Psychiatry Clin Pract 2015; 19:148-54. [PMID: 25363199 DOI: 10.3109/13651501.2014.980831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a progressive disorder that results in demyelinization of the nerve fibers of the central nervous system. We aimed to determine chronobiological and mood features in patients with MS. METHODS The sample comprised 75 patients with MS (54 women and 21 men) and 50 healthy individuals (38 women and 12 men). Sixty-three patients were relapsing-remitting MS and twelve patients had secondary progressive-type MS. Mood characteristics were assessed using subscales of the Profile of Mood States (POMS). Chronotypical characteristics were determined by the Morningness-Eveningness Questionnaire (MEQ). Univariate and structural equation modeling was applied to untangle the possible connections between variables. RESULTS Both relapsing-remitting and secondary progressive patients scored higher on the depression-dejection and fatigue-inertia scales of the POMS than healthy individuals. Circadian preferences did not differ significantly between these groups. Patients using glatiramer acetate and other types of drugs had greater severity of functional impairment measured relative to interferon-beta treatment group. Glatiramer acetate had more negative effects on mood than interferon-beta therapy. This finding may be the result of significantly higher duration of disease and higher symptom severity scores in glatiramer acetate group. CONCLUSIONS In the structural equation model, gender was found to be predictive for characteristics of mood.
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Affiliation(s)
- Pinar G Ozdemir
- Department of Psychiatry, Yuzuncu Yil University Medicine Faculty , Van , Turkey
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Fischer A, Schröder J, Vettorazzi E, Wolf OT, Pöttgen J, Lau S, Heesen C, Moritz S, Gold SM. An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial. Lancet Psychiatry 2015; 2:217-23. [PMID: 26359900 DOI: 10.1016/s2215-0366(14)00049-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/22/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND With a lifetime risk for major depressive disorder of up to 50%, depression is a common comorbidity in multiple sclerosis but remains widely underdiagnosed and untreated. We investigated the potential of a fully automated, internet-based, cognitive behavioural therapy programme, Deprexis, to reduce depressive symptoms in patients with multiple sclerosis. METHODS For this randomised controlled trial, we recruited patients from an outpatient clinic in Hamburg, Germany. Patients aged 18-65 years were eligible for inclusion if they had multiple sclerosis and self-reported depressive symptoms. By use of a computer-generated randomisation sequence, we allocated 90 patients (1:1; no blocking or stratification) to either the intervention group or a waitlist control group for 9 weeks. The primary endpoint was the Beck Depression Inventory (BDI), as assessed by an intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, number NCT01663649. FINDINGS 71 patients completed the trial: 35 patients in the intervention group and 36 patients in the control group. During the intervention, BDI scores decreased in the Deprexis group and increased in the control group, yielding a positive effect of Deprexis relative to the waitlist group (mean group difference -4·02 points [95% CI -7·26 to -0·79], p=0·015, effect size d=0·53). Worsening of depressive symptoms from below to above the clinical cutoff (BDI >13) occurred in three (7%) of 45 patients in the control group and no patients in the Deprexis group. We noted no adverse events with respect to new occurrence of suicidal ideation during the trial. INTERPRETATION Psychological online-intervention programmes could be suitable for patients with multiple sclerosis who are unable to regularly attend therapeutic sessions because of mobility impairments. FUNDING European Union and the Deutsche Forschungsgemeinschaft.
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Affiliation(s)
- Anja Fischer
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Ruhr-University, Bochum, Germany
| | - Jana Pöttgen
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Lau
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan M Gold
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Taylor KL, Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. Lifestyle factors, demographics and medications associated with depression risk in an international sample of people with multiple sclerosis. BMC Psychiatry 2014; 14:327. [PMID: 25467385 PMCID: PMC4263016 DOI: 10.1186/s12888-014-0327-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/10/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Depression is the most common co-morbidity for people with Multiple Sclerosis (MS); irrespective of disease severity, depression has the greatest impact on quality of life. An emerging paradigm in the treatment of depression is lifestyle medicine. There is significant potential to prevent and treat depression through modification of lifestyle risk factors for people with MS. This study sought to understand the association between lifestyle risk factors, medication and depression risk through the analysis of self-reported data from a large international sample of people with MS. METHODS This cross-sectional analysis recruited a total of 2459 participants via Web 2.0 platforms. Survey data included socio-demographics; a range of lifestyle risk factors; medication; disease variables and depression risk using the Patient Health Questionnaire-2 (PHQ-2). RESULTS In total approximately one fifth (19.3%) of our sample screened positive for depression (PHQ-2 score ≥3). Several demographic factors were significantly associated with this depression risk in bivariate analysis. Regression analyses showed that poor diet, low levels of exercise, obesity, smoking, marked social isolation and taking interferon were associated with greater depression risk. Participants who supplemented with omega 3s, particularly flaxseed oil, had frequent fish consumption, supplemented with vitamin D, meditated, and had moderate alcohol consumption had significantly reduced depression risk. CONCLUSIONS This study demonstrates a significant association between modifiable lifestyle factors and depression risk. Planned longitudinal follow up may clarify causality. Clinicians and people with MS should be aware of the wide range of modifiable lifestyle factors that may reduce depression risk as part of a comprehensive secondary and tertiary preventive medical approach to managing MS.
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Affiliation(s)
- Keryn L Taylor
- Department of Psychiatry, St Vincent's Hospital Melbourne, Victoria, VIC, 3065, Australia. .,Department of Medicine, The University of Melbourne St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Emily J Hadgkiss
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - George A Jelinek
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Tracey J Weiland
- Department of Medicine, The University of Melbourne St Vincent's Hospital, Melbourne, Victoria, Australia. .,Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Naresh G Pereira
- Faculty of Medicine, Notre Dame University, Fremantle, Western Australia, Australia.
| | - Claudia H Marck
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Dania M van der Meer
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
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Mrabet S, Ben Ali N, Kchaou M, Belal S. Depression in multiple sclerosis. Rev Neurol (Paris) 2014; 170:700-2. [DOI: 10.1016/j.neurol.2014.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/15/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
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Phillips LH, Henry JD, Nouzova E, Cooper C, Radlak B, Summers F. Difficulties with emotion regulation in multiple sclerosis: Links to executive function, mood, and quality of life. J Clin Exp Neuropsychol 2014; 36:831-42. [PMID: 25273836 DOI: 10.1080/13803395.2014.946891] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Little is known about the influence of multiple sclerosis (MS) on the regulation of emotion. The current study tested whether people with MS report more emotion regulation difficulties than healthy controls. The relationship between emotion regulation and other important variables (mood, quality of life, and executive function) was explored. Mediation models were used to further understand the links between emotion regulation, depressed mood, and executive function in MS. METHOD A total of 31 people with MS and 31 controls completed the Difficulties in Emotion Regulation Scales and measures of executive function (fluency and a go/no-go task), mood (Hospital Anxiety and Depression Scales), and a multidimensional assessment of quality of life (World Health Organization Quality of Life, brief version). RESULTS People with MS reported experiencing more difficulties in emotion regulation than controls. Mediation analyses indicated that depression mediated the emotion regulation difficulties in MS, while executive dysfunction did not. Difficulties in emotion regulation predicted poorer psychological and social quality of life in MS, independent of problems with executive function. CONCLUSIONS People with MS experience difficulties in emotion regulation, which predict poorer quality of life. These results indicate that emotional control skills should be investigated in further detail when considering interventions to enhance well-being in MS.
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